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[Results of the use of micafungin in newborns]
Salih Çağrı Çakır1, Solmaz Çelebi2, Hilal Özkan1
1Uludag University Faculty of Medicine, Department of Neonatology, Bursa, Turkey.
Abstract:
Invasive candidiasis is a common and serious infection in premature newborns. Preventing and treating fungal infections is very important to improve the prognosis of premature infants. Fluconazole and amphotericin B are used as the first choice in the treatment of invasive fungal infections of the newborns. In some cases, fluconazole and amphotericin B cannot be used due to nephrotoxicity, hepatotoxicity or resistant strains. Micafungin, which is among recently developed echinocandins, is the drug of choice in these cases. The use of micafungin in newborns is new and there is a limited experience about the effect of high dose usage in the central nervous system. The aim of this study was to evaluate the electronic files of patients who used micafungin for the treatment of culture-proven or possible invasive fungal infection during their hospital stay in the neonatal intensive care unit during a 24-month period (2016-2017) in the third-level intensive care unit. A total of 15 patients (10 premature and 5 term babies) were included in the study. The mean birth weight of the patients was 1732 ± 999 g and the mean gestational age was 32.2 ± 5.8 weeks. All patients had long-term intensive care and increased risk of invasive candidiasis infection. Central venous catheterization and multiple antibiotics usage were the most common risk factors in these patients. The other risk factors included intubation, total parenteral nutritional use and surgical procedure application. Candida species were isolated from the cultures of four patients. Candida species isolated from patients were Candida albicans, Candida glabrata, Candida catenulata, Candida parapsilosis. The mean time for onset of micafungin was 29.9 ± 16.6 days. Mean duration of micafungin therapy was 22.4 ± 11.2 days. Eight patients received amphotericin B, three patients received fluconazole therapy and four patients did not receive any antifungal therapy before the onset of micafungin. None of these patients had an abnormal kidney or liver function tests due to micafungin use. As a conclusion, high dose (10 mg/kg/day) micafungin is a safe and effective treatment choice both in the treatment of neonatal culture proven or probable invasive candida infections that were caused by refractory Candida strains, and in the case of nephrotoxicity and hepatotoxicity.
Insights
High-dose micafungin (10 mg/kg/day) is a safe and effective treatment for invasive fungal infections in newborns, especially when other antifungals fail due to toxicity or resistance. This study evaluated its use in neonatal intensive care units.
Area of Science:
- Neonatal Medicine
- Infectious Diseases
- Pharmacology
Background:
- Invasive candidiasis poses a significant threat to premature newborns, necessitating effective antifungal strategies.
- Fluconazole and amphotericin B are first-line treatments but can be limited by toxicity or drug resistance.
- Micafungin, an echinocandin, offers an alternative for difficult-to-treat neonatal fungal infections.
Purpose of the Study:
- To assess the safety and efficacy of high-dose micafungin (10 mg/kg/day) in treating invasive fungal infections in neonates.
- To evaluate micafungin use in a neonatal intensive care unit (NICU) setting, particularly for cases with toxicity or resistance to other antifungals.
Main Methods:
- Retrospective evaluation of electronic medical records for 15 neonates (10 premature, 5 term) treated with micafungin.
- Patients received micafungin for culture-proven or probable invasive fungal infections between 2016-2017 in a tertiary NICU.
- Data collected included patient demographics, risk factors, previous antifungal treatments, and micafungin treatment duration.
Main Results:
- No adverse kidney or liver function test abnormalities were observed in patients receiving micafungin.
- Common risk factors for invasive candidiasis included central venous catheterization, mechanical ventilation, and antibiotic use.
- Candida species isolated included C. albicans, C. glabrata, C. catenulata, and C. parapsilosis.
Conclusions:
- High-dose micafungin (10 mg/kg/day) demonstrated safety and efficacy in treating neonatal invasive candidiasis, including cases with resistant strains or intolerance to other antifungals.
- Micafungin represents a valuable therapeutic option for complex fungal infections in high-risk neonatal populations.
